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At least 19 recordsLinked to original sources
PubMed2002

Postoperative nausea and vomiting after craniotomy for tumor surgery: a comparison between awake craniotomy and general anesthesia.

STUDY OBJECTIVE: To assess the frequency of postoperative nausea and vomiting (PONV) in patients following an awake craniotomy compared to general anesthesia for tumor surgery. DESIGN: Prospective observational and chart review of all patients having a craniotomy for tumor during one year. SETTING: Postanesthesia care unit (PACU) and intensive care unit (ICU) of a university hospital. PATIENTS: 187 patients were reviewed. 107 patients who had a craniotomy for supratentorial tumor that was less than six hours in duration were analyzed and compared (50 awake craniotomy vs. 57 general anesthesia). INTERVENTIONS: Medical records were reviewed for events after the first four hours until discharge. The occurrence and the time of any nausea, vomiting; the administration of antiemetics and analgesic drugs; and complications were documented. MEASUREMENTS: Frequency of nausea, vomiting, administration of antiemetics and analgesia, and outcome between the two groups were compared using Chi-square and Student's t-test. MAIN RESULTS: The frequency of nausea (4% vs. 23%; p = 0.012) and vomiting (0% vs. 11%; p = 0.052) were less in patients having an awake craniotomy compared to general anesthesia, but only during the first four hours. The administration of postoperative analgesia was not different between the two groups and did not influence the frequency of PONV. CONCLUSION: The frequency of PONV during the initial recovery phase was less in patients having an awake craniotomy for tumor surgery than in patients having a similar procedure with general anesthesia.

Analgesics↗
PubMed2005

Post-craniotomy analgesia: current practices in British neurosurgical centres--a survey of post-craniotomy analgesic practices.

BACKGROUND AND OBJECTIVE: An evaluation of post-craniotomy analgesia within the University Hospital of Wales Neurosurgical Unit, Cardiff, found that many patients were experiencing moderate to severe pain post-craniotomy. It was therefore decided to undertake a nationwide survey of analgesic practices in order to establish best practice guidelines and benchmark with other units. METHOD: A postal questionnaire was sent to the senior nurse of every Neurosurgical Directorate within the UK inquiring about the current, standard analgesic practices for post-craniotomy patients in their unit. RESULTS: Completed replies were received from 23 of the 33 centres (70%). Intramuscular (i.m.) codeine phosphate was found to be the principal first-line analgesic used post-craniotomy. Only three centres used morphine as the first-line analgesic and only one centre used patient controlled analgesia routinely. The majority of centres (82%) used balanced analgesia. Pain assessments were only carried out in 57% of centres and no centre used a validated pain assessment tool specifically for dysphasic patients. CONCLUSIONS: Codeine phosphate continues to be the mainstay of post-craniotomy analgesia, however, it is proposed that patient controlled analgesia with morphine is an efficacious and safe alternative.

Analgesia↗
PubMed2005

The keyhole concept in aneurysm surgery--a comparative study: keyhole versus standard craniotomy.

OBJECTIVE: The purpose of the study is to compare the results of minimally invasive keyhole craniotomy and standard larger craniotomies in the surgical treatment of patients with intracranial aneurysms. METHODS: In the past eight years 628 patients were operated by two experienced neurosurgical teams. The first group of 482 patients with 565 aneurysms were operated through a small keyhole craniotomy, using the eyebrow keyhole approach in particular. The remaining 146 patients with 167 aneurysms were operated using a standard craniotomy that included pterional/frontotemporal, frontoparietal parasagittal, and retrosigmoid suboccipital craniotomies. All operations were performed in the standard microsurgical technique using intraoperative evoked potential monitoring and endoscopic assistance in selected cases. RESULTS: Most supratentorial aneurysms and basilar tip aneurysms were successfully operated through an eyebrow keyhole craniotomy. Distal MCA aneurysms as well as aneurysms on the MCA with a long M1 segment were operated through a temporal keyhole, and aneurysms of the distal PCA (P2-P3) segment subtemporally. The frontoparietal parasagittal keyhole approach was used only for pericallosal artery aneurysms. Infratentorial aneurysms of the VA/PICA complex were operated via a retrosigmoid approach. On comparing the surgery results in patients with a keyhole craniotomy and those with standard craniotomy, similar outcomes were found for both groups, with excellent or very good outcomes (GOS 5 and 4) in 398 (82.57%) patients from the keyhole craniotomy group, and in 116 (79.45%) patients from the standard craniotomy group. The mortality rate in the keyhole group was 0.83% (4 patients) and 2.05% (3 patients) in the standard craniotomy group. CONCLUSION: Parallel treatment results in using two options--keyhole craniotomy and standard larger craniotomy--were analysed in the past eight years. Two experienced neurosurgical teams in performing both surgical approaches have reached almost similar morbidity and mortality rates, and overall surgical results. The type of craniotomy is selected according to the experience of the surgical team, and familiarity with certain approach. The authors have good experience with the minimally invasive approach for different intracranial pathology and recommend it especially in neurovascular surgery.

Adolescent↗
PubMed2003

Comparison of standard large trauma craniotomy with routine craniotormy in treatment of acute subdural hematoma.

OBJECTIVE: To compare the therapeutic effect and indication between standard large trauma craniotomy and routine craniotomy. METHODS: There were 97 patients in the standard large trauma craniotomy group and 110 patients in the routine craniotomy group. The mortality, postoperative ICP (intracranial pressure), ratio of pupil rebound, complication and results of six month follow-up after operation were compared between the two groups. RESULTS: Fifteen patients (15.6%) died in the standard large trauma craniotomy group and 30 (27.7%) in the routine craniotomy group. The postoperative mean ICP was 3.75 kPa+/-1.89 kPa in the standard large trauma craniotomy group and 5.11 kPa+/-1.57 kPa in the routine craniotomy group. The pupil rebound was found in 47 patients (61.0%) in the standard large trauma craniotomy group and in 41 patients (46.1%) in the routine craniotomy group (P<0.01). The rate of complication was lower in the standard large trauma craniotomy group, but no obvious difference in long-term therapeutic effect was found between the two groups. CONCLUSIONS: Standard large trauma craniotomy can attenuate brain hernia and the mortality of the patients with acute subdural hematoma. The incidence of complication can also be decreased. But the long term life quality of the patients can not be improved.

Acute Disease↗
PubMed2003

High incidence and spontaneous resolution of mastoid effusion after craniotomy on early postoperative magnetic resonance images.

Mastoid effusion is a poorly understood complication after craniotomy. The incidence and severity of postoperative mastoid effusion were retrospectively examined on postoperative magnetic resonance (MR) images to assess any association with craniotomy procedures, time course, and neuro-otological complications. We evaluated the early postoperative MR images (within 4 days of craniotomy) and medical records of 74 patients who underwent 77 operations for the treatment of various intracranial diseases from January 2000 to December 2001. Mastoid effusion was classified into four grades: none, partial, moderate, and severe diffuse effusion in the mastoid air cells. Thirty-three follow-up MR images from 26 patients were also reviewed. Postoperative mastoid effusion occurred ipsilateral to the craniotomy site in 62 cases and contralateral in 56 cases. Mastoid effusion was significantly more severe ipsilateral than contralateral to craniotomy with exposure of the mastoid air cells ( P<0.0001). There was no significant difference in severity between the contralateral and ipsilateral sides after craniotomy without mastoid air cell opening ( P=0.437). Mastoid effusion following craniotomy without exposure of mastoid air cells resolved within 3 months. However, otitis media with effusion developed in six patients with severe mastoid effusion ipsilateral to craniotomy with exposure of the mastoid air cells. Mastoid effusion frequently developed on both sides. Any grade of mastoid effusion on the ipsilateral side to craniotomy without exposure of mastoid air cells, or on the contralateral side, was asymptomatic or had a benign course, and disappeared within 3 months.

Brain Neoplasms↗
PubMed1996

Relationship between the volume of craniotomies for cerebral aneurysm performed at New York state hospitals and in-hospital mortality.

BACKGROUND AND PURPOSE: After a craniotomy for cerebral aneurysm, postoperative mortality can be significant. Previous studies have shown that hospitals performing frequent high-risk procedures (such as coronary artery bypass) have a lower mortality than hospitals where these procedures are performed infrequently. METHODS: The Statewide Planning and Research Cooperative System of the New York State Department of Health reviewed all discharges in New York State from 1987 through 1993 for the diagnoses of subarachnoid hemorrhage and/or cerebral aneurysm and for patients with the procedure code for craniotomy for ruptured or unruptured cerebral aneurysm. In-hospital mortality and length of stay were examined in relation to the volume of craniotomies for aneurysm performed at each individual hospital. RESULTS: A total of 15,376 discharges for subarachnoid hemorrhage and 5638 craniotomies for aneurysm were tabulated in 208 hospitals. For all patients who underwent craniotomy for ruptured cerebral aneurysm (n = 4034), there was a 43% (95% confidence interval, 29% to 57%) reduction in mortality rate in hospitals performing more than 30 craniotomies per year for cerebral aneurysm compared with hospitals performing less surgery (8.8% versus 15.5%, P < .0001). For all patients who underwent craniotomy for unruptured cerebral aneurysm (n = 1604), there was an identical 43% (95% confidence interval, 14% to 73%) reduction in mortality in hospitals performing more than 30 craniotomies per year for cerebral aneurysm (4.6% versus 8.1%, P = .0087). CONCLUSIONS: Hospitals that frequently perform aneurysm operations have lower mortality rates for patients undergoing craniotomy for cerebral aneurysm than hospitals that perform fewer operations.

Aneurysm, Ruptured↗
PubMed2004

Effect of clipping, craniotomy, or intravascular coiling on cerebral vasospasm and patient outcome after aneurysmal subarachnoid hemorrhage.

OBJECTIVE: Although several recent studies have suggested that the incidence of vasospasm after aneurysmal subarachnoid hemorrhage is lower in patients undergoing aneurysmal coiling as compared with clipping, other studies have had conflicting results. We reviewed our experience over 8 years and assessed whether clipping, craniotomy, or coiling affects patient outcomes or the risk for vasospasm. METHODS: We included 515 patients with aneurysmal subarachnoid hemorrhage, identified prospectively from November 2000 to February 2003 (243 patients) and retrospectively from November 1995 to October 2000 (272 patients), by using International Classification of Diseases, 9th Revision, codes for subarachnoid hemorrhage. We classified patients as follows: clipping (413 patients), coiling (79 patients), and craniotomy (436 patients, including all 413 patients who underwent clipping plus 23 who underwent coiling as well as craniotomy for various reasons). We studied four outcome measures: total vasospasm, symptomatic vasospasm, poor outcome (modified Rankin score 3-6), and in-hospital mortality. To assess the risk of total vasospasm and symptomatic vasospasm, we performed multivariate regression analyses adjusting for age, Fisher grade, Hunt and Hess grade, aneurysm location (anterior versus posterior circulation), and aneurysm treatment modality. To assess the risk for poor outcome and in-hospital mortality, we adjusted for all the above variables as well as for total and symptomatic vasospasm. RESULTS: In the clipping group there was 63% total vasospasm and 28% symptomatic vasospasm; in the coiling group there was 54% total vasospasm and 33% symptomatic vasospasm; and in the craniotomy group there was 64% total vasospasm and 28% symptomatic vasospasm. In the multivariate analysis, age <50 years (P = 0.0099) and Fisher Grade 3 (P < 0.00001) predicted total vasospasm, and Fisher Grade 3 (P < 0.000001) and Hunt and Hess Grade IV or V (P = 0.018) predicted symptomatic vasospasm. Predictors of poor outcome were age >or=50 years (P < 0.0001), Fisher Grade 3 (P = 0.0072), Hunt and Hess Grade IV or V (P < 0.00001), symptomatic vasospasm (P < 0.0001), and coiling (P = 0.0314 versus clipping and P = 0.045 versus craniotomy). Predictors of in-hospital mortality were age >or= 50 years (P = 0.0030), Hunt and Hess Grade IV or V (P = 0.0001), symptomatic vasospasm (P < 0.00001), and coiling (P = 0.008 versus clipping and P = 0.0013 versus craniotomy). There was no significant difference in total vasospasm or symptomatic vasospasm when patients who underwent clipping or craniotomy were compared with patients who underwent coiling. In patients with Hunt and Hess Grade I to III ("good grade"), clipping and craniotomy were associated with better outcome and less in-hospital mortality, but there was no difference in total vasospasm or symptomatic vasospasm versus coiling. In patients with Hunt and Hess Grade IV or V ("poor grade"), there was no difference in any outcome measure among the treatment groups. CONCLUSION: In a single-center, retrospective, nonrandomized study, performance of clipping and/or craniotomy had significantly better outcome and lower mortality at discharge than coiling in good-grade patients but had no effect on total vasospasm or symptomatic vasospasm in good- or poor-grade patients.

Craniotomy↗
PubMed2006

One-piece versus two-piece orbitozygomatic craniotomy: quantitative and qualitative considerations.

OBJECTIVE: The orbitozygomatic (OZ) craniotomy minimizes brain retraction and improves cranial base exposure by providing a multidirectional view, increased operative angles and working space. The two main variations of the approach include the one-piece and the two-piece types. The microsurgical anatomy of the one- and two-piece OZ craniotomies are presented with the goal of comparing the extent of orbital roof removal between these two craniotomies and the effect of orbital roof removal on operative exposure. METHODS: Ten two-piece and 11 one-piece OZ craniotomies were performed in a stepwise manner simulating the approaches on formalin fixed specimens. The orbital surface area removed above the frontozygomatic suture extending medially over the orbital roof was measured from each bone flap. The two-sided unpaired t test using STATA 7.0 software was used to compare the amount of orbital roof removed using the two approaches. RESULTS: The two-piece OZ craniotomy allowed for the removal of a larger portion of the roof and lateral wall of the orbit than the one-piece. The total orbitotomy, including the orbital roof plus the part of the lateral wall above the frontozygomatic suture, had an average surface area of 996 +/- 229 mm for the two piece and 372 +/- 103 mm for the one-piece. The orbital roof made up 27 +/- 18% of the orbital osteotomy for the one-piece craniotomies and 67 +/- 10% of the osteotomy for the two-piece craniotomies (P < 0.001). CONCLUSION: The two-piece OZ craniotomy allows for more extensive orbital roof removal and better visualization of the basal frontal lobe. Therefore, the two-piece may result in a lower incidence of enophtalmus and poor cosmetic outcomes, particularly if the remaining orbital roof must be removed piecemeal during the one-piece OZ craniotomy in order to obtain satisfactory exposure.

Craniotomy↗
PubMed2002

Craniotomy for central nervous system metastases in epithelial ovarian carcinoma.

BACKGROUND: Although central nervous system (CNS) metastases from epithelial ovarian carcinoma are rare, recent studies indicate that the incidence may be increasing. Numerous series have reported various modalities for treatment with median survivals of 3 to 5 months, but the role of craniotomy has not been specifically addressed. METHODS: We conducted a retrospective review of all patients who underwent craniotomy between 1989 and 2001 for pathologically confirmed recurrent epithelial ovarian cancer metastatic to the CNS. RESULTS: We identified 14 patients who had a mean age at diagnosis of 59.3 years (range, 45 to 70). Distribution by stage and grade was as follows: Stage I, 0; II, 1; III, 12; and IV, 1; and grade 1,0; 2,4; and 3,10. Histologic distribution was as follows: papillary serous, 9; endometrioid, 2; mixed papillary serous and endometrioid, 1; carcinosarcoma, 1; and poorly differentiated adenocarcinoma, 1. Six patients had optimal primary cytoreduction, while 7 had suboptimal primary cytoreduction. All patients received initial platinum-based chemotherapy. Ten of 14 patients underwent second-look evaluation, and in 8 patients the findings were negative. The median time from initial diagnosis of ovarian carcinoma to CNS relapse was 3.5 years (range, 1.3 to 8.2). In 7 patients (50%), the CNS recurrence was the first site of relapse. Eight patients (57%) had extracranial disease at the time of craniotomy. Distribution of CNS lesions were as follows: supratentorial, 12; and cerebellar, 2. The mean operative time for craniotomy was 178 min (range, 70 to 305). The average blood loss was 125 mL (range, 20 to 250). The only major operative complications were deep vein thromboses that developed in two patients. No patient developed a neurologic deficit as a result of craniotomy. One patient died of progressive disease 37 days after surgery. Postoperative treatment included whole-brain radiation in 11 patients, chemotherapy in 4, and hormonal therapy in 4. Four patients (29%) had a CNS relapse after craniotomy. The median survival of patients after craniotomy was 18 months, and the 1- and 2-year survival rates were 66% (95% confidence interval (CI): 43-100) and 39% (95% CI: 17-90), respectively. CONCLUSIONS: Despite optimal cytoreduction, platinum-based chemotherapy, and negative second-look surgical assessment, patients with ovarian cancer can fail distantly with CNS metastases. Craniotomy with adjuvant radiation therapy can provide control of brain metastases in the majority of these patients and may result in improved survival over radiation therapy alone in selected patients.

Aged↗
PubMed2026

Retrosigmoid craniotomy surgical guide: The way forward for precise exposure of the transverse-sigmoid sinuses.

INTRODUCTION: The retrosigmoid craniotomy is the workhorse approach to the cerebellopontine angle. Accurate localisation of the transverse-sigmoid junction (TSJ) is key for optimised exposure and cerebellar retraction. Various methods, both anatomical and navigational, have been used but with suboptimal results. We utilised a 3D-printed retrosigmoid surgical guide in an attempt to overcome this and report our early outcomes and experiences in the design, production and utilisation of the guide. METHODS: This is a prospective cohort study of the patients with retrosigmoid craniotomies performed using the surgical guides. Patient demographics and diagnoses, along with the accuracy of the planned burrhole and craniotomy, need for craniotomy extension, presence of venous sinus injury, set-up time, and cost were reported. RESULTS: There were ten cerebellopontine angle cases in which the surgical guides were utilised, three petrous meningiomas, two trigeminal neuralgias, two metastasis, and three other tumours. The planned burrhole and craniotomy were precise in all cases with accurate exposure of the TSJ and no requirement for craniotomy extension. The mean set up time was 3.9&#xa0;min, and the mean cost of the surgical guides was USD 470.90. One elderly patient had an intraoperative transverse sinus injury related to adherent dura that was planned for exposure. CONCLUSION: The 3D-printed surgical guide is a potential solution to the rapid, precise and consistent identification of the TSJ when performing a retrosigmoid craniotomy. We present our early experience and discuss nuances in the designing, production, and intraoperative phases to optimise the precision of this guide. We suggest two methods to avoid sinus injury in elderly patients: either to plan the craniotomy to the edge of the sinus, or to plan sinus exposure but to use burr drills rather than the osteotome, as in our case, to expose the sinus.

Humans↗
PubMed2006

Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients.

BACKGROUND: This prospective study aimed to evaluate the safety, neurological outcomes, and cost-effectiveness of 3 surgical procedures for spontaneous basal ganglia hemorrhage. METHODS: Ninety noncomatose patients with basal ganglia hemorrhages were randomized into 3 groups. Group A (n = 30) underwent endoscopic surgery, group B (n = 30) underwent stereotactic aspiration, and group C (n = 30) underwent craniotomy. Waiting time of surgery, length of operation time, and blood loss were compared between all groups. On the second operative day, we evaluated the amount of residual hematoma and the hematoma evacuation rate by computed tomography scan. Surgical mortality and complications were recorded 3 months after the procedure. Neurological outcomes were evaluated by functional independence measure (FIM) score, Barthel index score, and muscle power (MP) of affected limbs 6 months after surgery. We also evaluated the cost-effectiveness of each procedure. RESULTS: There was significant delay in waiting timing of the stereotactic aspiration (172.56 +/- 93.18 minutes; P < .001). Craniotomy had the longest operation time (229.96 +/- 50.57 minutes; P < .001). Blood loss was most significant in the craniotomy (236.13 +/- 137.45 mL; P < .001). The highest hematoma evacuation rate was seen in the endoscopic surgery (87% +/- 8%; P < .01). The mortality rate was 0% in group A, 6.7% in group B, and 13.3% in group C (P = .21). The complication rate was 3.3% in group A, 10% in group B, and 16.6% in group C (P = .62). The most major complications were rebleeding and infection. The FIM score was higher in the endoscopic surgery (79.90 +/- 36.64) than in the craniotomy (33.84 +/- 18.99; P = .001). The Barthel index score was also significantly better in the endoscopic surgery (50.45 +/- 28.59) than in the craniotomy (16.39 +/- 20.93; P = .006). There was more improvement in MP of affected limbs in endoscopic surgery than in craniotomy (P = .004). Endoscopic surgery was more cost-effective than craniotomy using FIM and Barthel index (P < .02 and P < .05, respectively). CONCLUSIONS: Both endoscopic surgery and stereotactic aspiration are minimally invasive and are effective procedures with low complication and mortality rates; however, the waiting timing of stereotactic aspiration is usually longer. Endoscopic surgery may be an appropriate substitute for stereotactic aspiration. It produces good neurological outcomes and aids in rapid hematoma evacuation. Craniotomy may be used for emergency decompression of enlarged hematoma if endoscopic surgery or stereotactic aspiration is not available.

Adult↗
PubMed2001

Outpatient craniotomy for brain tumor: a pilot feasibility study in 46 patients.

BACKGROUND: Since 1991 the author has routinely performed awake craniotomy for intra-axial brain tumors with low complication rate and low resource utilization. In late 1996 a pilot study was initiated to assess the feasibility of performing craniotomy for tumor resection as an outpatient procedure. METHODS: A rigorous protocol was developed and adhered to, based around the patient's arrival at hospital at 6:00 a.m, undergoing image-guided awake craniotomy with cortical mapping, and being discharged by 6:00 p.m. RESULTS: During the 48 month period from December 1996 to December 2000, 245 awake craniotomies were performed and of those, 46 patients were entered into the outpatient craniotomy protocol. Pathology in the 46 intent-to-treat group was: 21 metastasis, 19 glioma, and six miscellaneous. Four patients required conversion to inpatients and one patient was readmitted later the same evening due to headache. Thus 41/46 patients successfully completed the protocol (89%). There were five complications in the 46 intent-to-treat group (10.9%). CONCLUSIONS: Outpatient craniotomy for brain tumor is a feasible option which appears safe and effective for selected patients. Besides being resource-friendly, the procedure may be psychologically less traumatic to patients than standard craniotomy for brain tumor. Proper prospective studies including satisfaction surveys would help resolve these issues and will be the next step.

Adolescent↗
PubMed2003

Harvesting blood stem cells from cranial bone at craniotomy--a preliminary study.

Primary brain tumors seldom infiltrate into the cranium, even if they are invasive in the central nervous system. In this study, we examined whether blood stem cells can be harvested from cranial bone at craniotomy. Bone marrow cells in cranial bone were counted in 181 craniotomy specimens after staining with hematoxylin and eosin. Marrow volume was measured in 37 specimens using three-dimensional computed tomography (CT). In 10 cases, viable cells collected from very small bone pieces at craniotomy were cultured to examine granulocyte/macrophage colony-forming units (CFU-GM). In 2 cases, bone marrow cells were practically harvested from removed bone at surgery. The weight of bone flap at craniotomy was 35.0 +/- 18.0 g. Bone flap marrow contained 1.5 x 10(9) cells/ml. CT examination showed that bone flap volume was 35.0 +/- 9.0 ml and marrow ratio was 65.1 +/- 13.5%. Thus, at craniotomy, a typical bone flap contained about 3.4 x 10(10) cells. Bone marrow cell count gradually decreased as subject age increased. The bone pieces obtained at craniotomy contained 3.1 +/- 3.4 x 10(6) cells/g, and CFU-GM count was 0.4 x 10(5) cells/g. In one case, we collected 3.4 x 10(8) cells, including 1.8 x 10(6) CFU-GM colonies. In another case, we collected 9.7 x 10(8) cells, including 4.8 x 10(6) CFU-GM colonies. These findings indicate that, at craniotomy, the number of blood stem cells in a typical bone flap is sufficient for autologous blood stem cell rescue.

Adolescent↗
PubMed2003

Effect of decompression craniotomy on increase of contusion volume and functional outcome after controlled cortical impact in mice.

If, how, and when decompressive craniotomy should be used for the treatment of increased intracranial pressure after traumatic brain injury are widely discussed clinical subjects. Despite the large number of clinical studies addressing this issue, experimental evidence of a beneficial or detrimental role of decompressive craniotomy after brain trauma is sparse. Therefore, we investigated the influence of craniotomy on intracranial pressure, contusion volume, and functional outcome in a model of traumatic brain injury in mice. Male C57/Bl6 mice were craniotomized above the right parietal cortex and were subjected to controlled cortical impact injury. In control mice, the craniotomy was closed immediately after trauma, whereas in treated animals the craniotomy was left open. In control mice intracranial pressure (ICP) increased to a maximum of 23.7 +/- 3.1 mm Hg 6 h after trauma (p < 0.001), while in craniotomized animals, no ICP increase was observed. Twenty-four hours after trauma, the point in time of maximal lesion expansion, contusion volume in craniotomized mice was 40% smaller as compared to controls (18.3 +/- 2.0 vs. 30.2 +/- 3.5 mm(3), p < 0.04). Furthermore, craniotomized mice showed significantly improved motor function in a beam walking task (p < 0.04) and faster recovery of body weight after trauma (p < 0.02). Our results demonstrate that craniotomy blunts post-traumatic ICP increase, significantly reduces secondary brain damage and improves functional outcome after experimental TBI. Careful clinical evaluation of craniotomy as a therapeutic option after TBI in man may therefore be indicated.

Animals↗
PubMed1996

Pseudoankylosis of the mandible after supratentorial craniotomy.

After temporal craniotomy, pseudoankylosis of the mandible can cause difficult airway management during subsequent anesthesia. However, postcraniotomy changes in maximal mouth opening and the incidence of limited mouth opening have not been characterized. Ninety-two adult patients who underwent elective craniotomy were divided into three groups: Group A (n = 28) included patients who underwent parietal, occipital, or frontal craniotomy without incision of the temporalis muscles; Group B (n = 25) included patients who underwent temporal craniotomy; and Group C (n = 39) included patients who underwent frontotemporal craniotomy. Maximal mouth opening (interincisor gap) and the frequency of limited mouth opening (maximum mouth opening < or = 2.5 cm) were evaluated before operation and 3 days, 1 wk, 2 wk, 1 mo, and 3 mo after operation. The three groups did not differ with respect to age, sex, body weight, height, operative time, anesthetic time, or maximum mouth opening before operation. The postoperative reduction in maximal mouth opening was significantly greater in Group C than in Group B. In Group C, the incidence of limited mouth opening was 33.3% and 20.5% 2 wk and 1 mo after operation, respectively; however, limited mouth opening resolved within 3 mo in most patients. Supratentorial craniotomies separated by short intervals can increase the risk of limiting the mandibular opening, which may result in a difficult intubation. Careful preoperative assessment of the airway is mandatory if patients have previously undergone temporal or frontotemporal craniotomy.

Adult↗
PubMed1995

Decompressive craniotomy for acute shaken/impact baby syndrome.

To estimate the surgical efficacy of decompressive craniotomy, 23 children under 2 years of age with acute shaken/impact baby syndrome were treated with medical or surgical methods over the past 6 years. Six children (group A) with lower intracranial pressure (ICP, less than 30 mm Hg) were treated with medical therapy, and 17 children with high ICP (more than 30 mm Hg) of which 7 children were treated with medical therapy (group B) and another 10 children (group C) were treated with decompressive craniotomy. Bifrontal craniotomy was performed on 5 children with generalized brain swelling. A large frontotemporoparietal craniotomy was performed on another 5 children with unilateral swelling. A mean of 32 ml of subdural hematoma was removed. The mean ICP was reduced by 80% in the craniotomy group, p < 0.05. Children in groups A and C performed better on the Children's Outcome Scale than those in group B, p < 0.05. Mortality was significantly lower (0/10) in group C than in group B (3/7), p < 0.05. Hearing preservation was better in group C than in group B, p < 0.05. Bifrontal and frontotemporoparietal craniotomies may reduce mortality and morbidity for acute shaken/impact baby syndrome with high ICP. Patients with ICP less than 30 mm Hg may be treated successfully with medical therapy and patients with ICP more than 30 mm Hg are better treated with decompressive craniotomy.

Battered Child Syndrome↗
PubMed2003

Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project.

OBJECT: In many new clinical trials of patients with malignant gliomas surgical intervention is incorporated as an integral part of tumor-directed interstitial therapies such as gene therapy, biodegradable wafer placement, and immunotherapy. Assessment of toxicity is a major component of evaluating these novel therapeutic interventions, but this must be done in light of known complication rates of craniotomy for tumor resection. Factors predicting neurological outcome would also be helpful for patient selection for surgically based clinical trials. METHODS: The Glioma Outcome Project is a prospectively compiled database containing information on 788 patients with malignant gliomas that captured clinical practice patterns and patient outcomes. Patients in this series who underwent their first or second craniotomy were analyzed separately for presenting symptoms, tumor and patient characteristics, and perioperative complications. Preoperative and intraoperative factors possibly related to neurological outcome were evaluated. There were 408 patients who underwent first craniotomies (C1 group) and 91 patients who underwent second ones (C2 group). Both groups had similar patient and tumor characteristics except for their median age (55 years in the C1 group compared with 50 years in the C2 group; p = 0.006). Headache was more common at presentation in the C1 group, whereas papilledema and an altered level of consciousness were more common at presentation in patients undergoing second surgeries. Perioperative complications occurred in 24% of patients in the C1 group and 33% of patients in the C2 group (p = 0.1). Most patients were the same or better neurologically after surgery, but more patients in the C2 group (18%) displayed a worsened neurological status than those in the C1 group (8%; p = 0.007). The Karnofsky Performance Scale score and, in patients in the C2 group, tumor size were important neurological outcome predictors. Regional complications occurred at similar rates in both groups. Systemic infections occurred more frequently in the C2 group (4.4 compared with 0%; p < 0.0001) as did depression (20 compared with 11%; p = 0.02). The perioperative mortality rate was 1.5% for the C1 group and 2.2% for the C2 group (p = not significant). The median length of the hospital stay was 4 days in each group. CONCLUSIONS: Perioperative complications occur slightly more often following a second craniotomy for malignant glioma than after the first craniotomy. This should be considered when evaluating toxicities from intraoperative local therapies requiring craniotomy. Nevertheless, most patients are neurologically stable or improved after either their first or second craniotomy. This data set may serve as a benchmark for neurosurgeons and others in a discussion of operative risks in patients with malignant gliomas.

Central Nervous System Neoplasms↗